Salvage topical therapy for upper tract urothelial carcinoma

Balasubramanian, Adithya; Metcalfe, Michael; Wagenheim, Gavin; Xiao, Lianchun; Papadopoulos, John; Navai, Neema; Davis, John W.; Karam, Jose A.; Kamat, Ashish M.; Wood, Christopher G.; Dinney, Colin P.; Matin, Surena F.

doi:10.1007/s00345-018-2349-9

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…Five renal units had CIS unresponsive to initial therapy and only 20% (1/5) of these responded to additional intraluminal therapy. Globally these data support that there are some cases of UTUC that can be salvaged with additional courses of intraluminal therapy, but those presenting with CIS may not do as well [ 43 ].…”

Section: Intraluminal Therapiesmentioning

confidence: 82%

“…Last, Balasubramanian et al [ 43 ] reported their findings in a cohort of 51 patients (58 renal units) which received salvage topical therapy (either BCG, MMC, or gemcitabine) for recurrent UTUC (Ta, T1, and Tis). Of note, 18 renal units required additional topical therapy—44% (8/18) for refractory disease and 56% (10/18) as a reinduction course following a period of remission.…”

Section: Intraluminal Therapiesmentioning

confidence: 99%

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Nephron-sparing management of upper tract urothelial carcinoma

et al. 2021

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Urothelial carcinoma of the upper urinary tract is uncommon and presents unique challenges for diagnosis and management. Nephroureterectomy has been the preferred management option, but it is associated with significant morbidity. Nephron-sparing treatments are a valuable alternative and provide similar efficacy in select cases. A PubMed literature review was performed in English language publications using the following search terms: urothelial carcinoma, upper tract, nephron-sparing, intraluminal and systemic therapy. Contemporary papers published within the last 10 years were primarily included. Where encountered, systematic reviews and meta-analyses were given priority, as were randomized controlled trials for newer treatments. Core guidelines were referenced and citations reviewed for inclusion. A summary of epidemiological data, clinical diagnosis, staging, and treatments focusing on nephron-sparing approaches to upper tract urothelial carcinoma (UTUC) are outlined. Nephron-sparing management strategies are viable options to consider in patients with favorable features of UTUC. Adjunctive therapies are being investigated but the data remains mixed. Protocol variability and dosage differences limit statistical interpretation. New mechanisms to improve treatment dwell times in the upper tracts are being designed with promising preliminary results. Studies investigating systemic therapies are ongoing but implications for nephron-sparing management are uncertain. Nephron-sparing management is an acceptable treatment modality best suited for favorable disease. More work is needed to determine if intraluminal and/or systemic therapies can further optimize treatment outcomes beyond resection alone.

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Section: Intraluminal Therapiesmentioning

confidence: 82%

Section: Intraluminal Therapiesmentioning

confidence: 99%

Nephron-sparing management of upper tract urothelial carcinoma

et al. 2021

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“…Increasing comorbidity is indeed the main limitation to surgical practice in older patients: in fact, conservative treatment and adjuvant topical therapy could be proposed in very selected UTUC cases. 15 . According to previous literature, 7 , 8 we reported comparable OS after SU, and RNU also in the subgroup of patients older than 75 years of age.…”

Section: Discussionmentioning

confidence: 99%

Segmental Ureterectomy Versus Radical Nephroureterectomy in Older Patients Treated for Upper Tract Urothelial Carcinoma

Abrate¹,

Sessa²,

Sessa³

et al. 2022

Clinical Genitourinary Cancer

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“…Perkütan nefrostomi, ultrasonografi (USG) veya floroskopi eşliğinde ürologlar veya girişimsel radyologlar tarafından takılmaktadır (3). Vakaların çoğunluğunu taş ve malignitelere sekonder gelişen üriner obstrüksiyonlar oluştururken gebelik hidronefrozu, pyonefroz tedavisi, üriner sistem fistülleri, konjenital anomaliler (üreteropelvik bileşke darlığı, üreterovezikal bileşke darlığı vs.) diğer nedenlerdir (4,5).…”

Section: Amaçunclassified

Üroloji pratiğinde acil perkütan nefrostominin yeri; tek merkez deneyimi

et al. 2022

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Amaç: Bu çalışmada perkütan nefrostominin üroloji pratiğindeki önemini değerlendirmeyi amaçladık.Gereç ve Yöntemler: Ocak 2014 ile Ocak 2021 yılları arasında üroloji kliniğinde perkütan nefrostomi takılan hastaların kayıtları retrospektif olarak incelendi. Pyonefroz ve/veya böbrek fonksiyon testi yüksekliği tespit edilen ve acil şartlarda ürologlar tarafından perkütan nefrostomi takılan hastalar çalışmaya dahil edildi. Hastaların yaşları, hastaneye başvuru nedenleri, hidronefroz derecesi, primer patolojileri, işlem sonrası komplikasyonlar ve işlem sonrası yapılan elektif tedavileri değerlendirildi.Bulgular: Çalışmaya dahil edilen 164 hastanın 98’i erkek ve 66’sı kadındı. Hastaların ortalama yaşı 47,45 (18-90) yıl idi. Hastaların 120’sine tek taraflı, 44’üne ise bilateral olmak üzere toplam 208 renal üniteye perkütan nefrostomi katateri takıldı. 208 renal ünitenin 192’sinde (%95,2) perkütan nefrostomi başarılı bir şekilde takılırken, 10 (%4,8) renal ünitede işlem başarısız oldu ve ek girişim gerekti. Hastaların %40,2’sine onkolojik nedenlerden, %59,8’ine ise onkolojik dışı nedenlerden perkütan nefrostomi kateteri takıldı. İşlem sonrası minör komplikasyonlardan en sık görüleni transfüzyon gerektirmeyen geçici hematüri (%3,2) olup, ateş (%2,4), işlem sonrası devam eden ağrı (%1,6), kateter tıkanması (%0,8) ve geçici idrar sızıntısı (%0,8) diğer minör komplikasyonlardı. Majör komplikasyonlardan ise en sık görüleni ise nefrostominin yerinden çıkması (%3,2) idi.Sonuç: Perkütan nefrostomi obstrüktif üropati, pyonefroz tedavisi ve üriner diversiyon amacıyla uygulanan, yüksek başarı oranına sahip, etkili ve güvenli bir yöntemdir. Son zamanlarda girişimsel radyologlar tarafından daha fazla uygulanıyor olsa da ürologlar tarafından da başarılı bir şekilde uygulanabilmektedir.

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Salvage topical therapy for upper tract urothelial carcinoma

Abstract: Our data provide preliminary clinical rationale for the second-line TT for refractory and recurrent, endoscopically managed papillary UTUC in patients ineligible for or refusing nephroureterectomy. However, refractory upper tract CIS appears to have poor response to salvage TT.

Cited by 12 publications

References 23 publications

Nephron-sparing management of upper tract urothelial carcinoma

Nephron-sparing management of upper tract urothelial carcinoma

Segmental Ureterectomy Versus Radical Nephroureterectomy in Older Patients Treated for Upper Tract Urothelial Carcinoma

Üroloji pratiğinde acil perkütan nefrostominin yeri; tek merkez deneyimi

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